archive-2022-no1

Zarami AB, Chiwar H, Bata MG, Nggada HA, Pindiga UH

Background: Epstein-Barr virus (EBV)-associated adenocarcinoma constitutes 10% of gastric carcinomas worldwide. The EBV-positive adenocarcinoma has a unique genomic aberration with a low mutation burden and thus carries a good prognosis. The distinct salient genomic features have provided a guide to targeted therapy and the possibility of a clinical trial for emerging drugs in EBV-positive gastric adenocarcinomas. We retrospectively reviewed ten cases to determine the frequency of this association in our environment. Methods: The study was an analytical case-control study. Non-probably purposive sampling method was adopted; ten formalin-fixed and paraffin-embedded tissue blocks from surgically resected gastric adenocarcinoma seen at the Histopathology Department of the University of Maiduguri Teaching Hospital were selected and used. The PCR was done at National Trypanosomiasis Centre, Kaduna using 129 bp primers. The patient biodata and EBV status were entered into a computer and analysed using SPSS version 23. Proportions were calculated using the Chi-square test and a p-value of <0.05 was considered statistically significant. Results: Ten cases were retrieved. There were 6 females and 4 males with F:M ratio of 3:2 and a mean age of 52.7 ± 10.26 SD with an SE of 0.661. Seventy percent of the cases were positive for EBV while 30% were negative. Four out of the 6 females were positive for EBV DNA and 3 out of the 4 males were positive for EBV DNA. Fifty percent of the positive cases were found within their 4th decade of Life. There was no statistical significance between the histological types and EBV status (p=0.467). Conclusion: The study has shown a high frequency of EBV-DNA detection in patients with gastric adenocarcinoma in our environment, with 50 % occurring in the 4th decade of life. We recommend a further study with larger sample size and analysis of exome and genome sequencing of EBV in patients with gastric adenocarcinoma to increase our understanding of its prognosis and treatment.

Keywords: EBV-DNA, PCR, Gastric adenocarcinoma, Targeted immunotherapy

Background: Inappropriate estimation of endotracheal tube pressure can result in significant harm to the patient, and the use of a manometer is the only reliable way of ensuring an optimal pressure range (20-30cmH2O). In the absence of a manometer, the Pilot balloon palpation (PBP) technique is commonly employed in our environment.

Aim: This study compared the accuracy of a newer method of ETTc inflation called passive release technique using loss of resistance (LOR) syringe with the PBP technique in determining optimal ETTc pressure.

Methods: One hundred and eighty ASA I and II patients, aged 18 – 65 years, scheduled for elective procedures under general anesthesia with ETT were randomized into 2 groups with one group having their cuff pressures measured by pilot balloon palpation (PBP) and the other using a loss of resistance syringe (LOR). The cuff pressure was then measured in each group using a sensitive manometer.

Results: The mean ETTc pressure was found to be significantly higher in the PBP group than in the LOR group (64.28 ± 31.12 and 29.64 ± 11.68; p= 0.0001). The LOR technique was found to be significantly more accurate in ETTc pressure estimation than the PBP techniques (59.3 vs 27.8%; p = 0.0001).

Conclusion: Passive release technique using LOR was found to be significantly more accurate compared to PBP in optimal ETTc pressure estimation.

Key words: Endotracheal tube cuff pressure, pilot balloon palpation, loss of resistance syringe.

Musami U.B, Abdulmalik J.O, M. W Ali, Dahiru A. M. C, Mahmood M. Y, Wakawa I. A

Background: North-Eastern Nigeria has high birth rates, low literacy levels and low rates of premarital screening for haemoglobin genotype. This probably explains the high prevalence of sickle cell disease (SCD) among children and adolescents. SCD is a chronic disease associated with high rates of co-morbid mental health disorders affecting both the sufferers and caregivers. Despite this burden, there are very few studies that evaluated mental health disorders among people living with SCD in this region.

Objectives: To determine the prevalence of depression, suicidality, and anxiety among children and adolescents with SCD and the sociodemographic correlates associated with them.

Methods: This was a single-centre, hospital-based, cross-sectional study conducted at the University of Maiduguri Teaching Hospital. Children and adolescents with SCD were recruited for the study and issued a pretested sociodemographic questionnaire (Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Aged Children Present and Lifetime Version [K-SADS-PL]). Data was analysed using SPSS version 20.

Results: There were a total of 165 participants with a mean age of 11.2 ± 3.2 years comprising 83 (51.9%) males. Majority (98.1%) had only primary education, and most (83.8%) reside in an urban area. About 77% were diagnosed to have SCD before the age of 8, and 57.5% have received care for more than 5 years. Emotional disorders were present in 53.1% of the participants. These consist of anxiety disorder 38.1%, separation anxiety 28.8%, depression 20.6%, agoraphobia 13.1%, suicidality 5%, panic disorder 3.8%, social phobia/ specific phobia 3.1%, and general anxiety disorder 2.5% respectively. Statistically significant association (P<0.005) was found between emotional disorders and monogamous families, and parents’ occupation,

Conclusion: There is a high prevalence of emotional disorders amongst children and adolescents living with sickle cell disease attending clinics in Maiduguri, which correlated with monogamous family structure, low socioeconomic status. Routine screening for emotional disorders among children and adolescents living with chronic disorders attending the paediatric clinic should be considered and psychosocial support should be provided.

Key words: Emotional disorders, sickle cell disease, Nigeria

Rabiu A, Getso HA, Mahmud A

Background: Many studies have shown that working mothers face challenges in achieving exclusive breastfeeding (EBF). The practice of breast milk expression (BME) is an important strategy to achieve EBF. Aim: To assess the practice and influence of BME on EBF among working mothers with infants up to six months of age attending the immunization clinic of Aminu Kano Teaching Hospital (AKTH), Kano.

Methods: This was across-sectionall study among working breastfeeding mothers attending the immunization clinic of AKTH. A structured interviewer-administered questionnaire was used to obtain data on knowledge and practice of BME. Data collected were analysed using SPSS windows version 21. A χ2 test was used to compare variables where appropriate.

Result: Three hundred and ten breast feeding mothers participated in the survey. The mean age ±SD of respondents were (30.68 ± 5.6). Their median parity was 3. Only 103(33.2%) practiced BME. Reason given by half (54.8%) of respondents who practiced BME was to achieve six months of EBF which was found to be statistically significant (p-value =0.001).

Conclusion: Although most working mothers have fair knowledge on expression and storage of breast milk, only a minority put that into practice, and the main reason for practicing BME was to achieve six months of EBF. Age of mother, ethnicity and reason for BME were found to be statistically significant (χ2 = 52.7, P= 0.01), (χ2 =7.99, P = 0.046), (χ2 = 305.5, P = 0.001).

Key words: Breast milk Expression, Exclusive Breast Feeding, Influence, Practice.

Nafisat T. Abdullahi, Rabiu I. Jalo, Abubakar S. Abubakar, Usman M. Ibrahim, Shaheeda L. Farouk, Aminatu A. Kwaku, Fatimah I. Tsiga-Ahmed, Aishatu L. Adamu, Musa M. Bello, Amole T. Gboluwaga, Auwalu U. Gajida, Isa S. Abubakar

Background: Ensuring access to skilled birth attendants (SBA) during childbirth is critical for maternal and newborn survival, especially in underserved rural communities of northern Nigeria.

Methods: We assessed the utilisation of SBA in rural communities of Kano state. Using a cross-sectional study design with a concurrent mixed method of data collection, multi-stage and purposive sampling techniques were employed to select respondents of the quantitative and qualitative components of the study, respectively. Focus group discussions and key informant interviews were conducted to assess the perception of women, husbands and delivery service providers regarding the utilisation of SBA.

Results: Of the 194 women, 38(19.6%) were attended to by SBA, 138(71.1%) by unskilled birth attendants and 18(9.3%) had solitary birth. Furthermore, facility-based delivery was only 14.9% as the majority of the women delivered at home. Previous hospital delivery (p=0.02, aOR = 4.5; 95% CI=1.4-14.8) and husband’s level of education (p=0.03, OR = 5.9; 95% CI=1.3-27.3) were found to be independent predictors of utilisation of SBA. Perceptions regarding utilisation of SBA varied, ranging from a general preference for home delivery with the assistance of a traditional birth attendant to a predisposition towards hospital delivery with the assistance of SBA. Factors that contributed to adherence to traditional birthing practices included healthcare workers’ negative attitudes, manpower gap, lack of equipment and supplies and inadequate functioning health facilities.

Conclusion: Utilisation of SBA in rural communities of Kano state is low. Efforts should be made to increase women’s and men’s awareness, improve health facilities, and ensure improved and equitable access and availability of skilled delivery care services.

Keywords: utilisation, skilled birth attendant, women, rural, Kano

Nosakhare J. Iduoriyekemwen, Alphonsus N. Onyiriuka, Wilson E. Sadoh, Moses T. Abiodun

Timothy A. Ehwarieme1 and Anwuli Emina2

Background: Hypertension is a public health challenge that has been increasing alarmingly in both low and high-income countries. This study aims to determine the prevalence of hypertension and its associated factors among adult residents in Imoru community.

Methods: A descriptive cross-sectional design was used to surveysample size of 316 randomly selected participants. A well-structured questionnaire, blood pressure apparatus, weighing scale, and calibrated meter rule were used to collect data. Data were analyzed using descriptive statistics and hypothesis tested using multiple logistic regression at a 5% level of significance. Result: Of the 316(100%) participants, 177(56%) were males with M: F ratio of 1:0.79. The prevalence of hypertension was found to be 37.7%. The level of knowledge of Hypertension is evenly distributed with 83(26.3%) having poor knowledge, 152(48.1%) having fair knowledge, and 81(25.6%) having good knowledge. Risk factors identified are consumption of fatty food, adding table salt to meals, performing stressful activities, consumption of red meat, consumption of processed and canned foods, and addition of condiments to foods (average mean >2.5). Factors influencing these practices are affordability, availability, culture, and ignorance. There is a positive significant correlation of SBP (R2 = 0.1854, p =0.021; p =0.002) /DBP (R2 = 0.0458, p =0.002) and BMI. Females are two times (OR: 1.86; CI = 0.343-2.159) more likely to have good knowledge than males.

Conclusion: There is a high prevalence of hypertension in the study population. There is a need for concerted efforts by health policymakers and all stakeholders towards putting in place effective primary and secondary preventive strategies.

Keywords: Knowledge, risk factors, hypertension, Prevalence, Practices associated with risk

Adamu Abubakar. Abba Bukar Z. Ahmed Mohammed N. Amina Muhammad A. Aliyu Mohammad Kodiya

Background: Kaposi sarcoma (KS) is an uncommon vascular neoplasm that commonly involves the skin of the upper and lower extremity and to a lesser extent, mucosa of the different anatomical sites of the body. It rarely occurs in the head and neck mucosa, the most common site being the oral cavity. Nasal mucosal involvement is extremely rare. To the best of our knowledge, only nine cases of KS of the nasal cavity were reported in the English literature. We present a rare differential to be considered when dealing with patients with nasal mass.

Case summary: A 47 year old Nigerian woman presented with 3 years history of recurrent epistaxis, a right nasal mass, progressive right nasal obstruction, rhinorrhoea and anosmia. She is diabetic and hypertensive. Examination revealed a polypoid mass occupying the whole of the right cavity with associated contact bleeding.

Conclusion: Nasal KS is a rare malignancy that involved the nasal mucosa. To our knowledge, only nine cases of primary nasal KS were reported in the literature of which only a few were not associated with AIDS. Though rare, it should be entertained as one of the differential diagnoses of nasal masses in adults even in those with HIV-negative status We present the fifth case of primary nasal KS not associated with AID
Keywords: Kaposi sarcoma, nasal cavity, acquired immunodeficiency syndrome

Background: Osteochondritis is a necrotic involvement of the subchondral bone and cartilage opposite. Its most common location is the medial femoral condyle. The technique of Wagner’s autoplastic grafting was modified or adapted to a limited technical platform. To share an unusual experience with the scientific community.

Summary: A dissected osteochondritis of the left femoral condyle was diagnosed in a 15-year-old patient. The treatment was a modified open-centre surgery according to Wagner. The results were satisfactory in both immediate and late post-surgery.

Discussion: The classic Wagner technique uses a unique plugin that is fixed by patching. In this work, the graft was triple and fixed by screws.

Conclusion: The working conditions can lead to the use of a modified classical technique

Keywords: Femur; Mosaicoplasty; Osteochondritis

Zarami AB, Abe MA, Adamu AI, Tarfa H, Pindiga UH

Background: Xanthogranulomatous inflammation (XGI) is a rare form of chronic inflammation characterized by the presence of lipid-laden macrophages, multinucleated giant cells, and cholesterol crystals. It is an uncommon finding in the breast. Our literature search revealed twenty-four documented cases in the English literature.
Case report: An 18-year-old female presented with a mass in the left upper lateral quadrant of the breast with ulceration for a 1-month duration. The mass was initially small about 2cm in its widest diameter and continued to increase in size to 5 x 3 cm. The overlying skin is smooth and not attached to the underlying structures. It is firm with mild tenderness and ill-defined margins. Two months later she developed a left breast ulcer that measured 2 x 1 cm on the surface of the lump. It has a sloping edge with a necrotic floor. There was no associated axillary lymphadenopathy. Fine needle aspiration cytology suggested an inflammatory process. Tissue biopsy histology shows abundant foam cells, multinucleated giant cells of foreign body type as well as numerous lymphoplasma cells infiltrating the breast tissue with geographic areas of necrosis in keeping with xanthogranulomatous mastitis.
Conclusion: Xanthogranulomatous mastitis is a very rare entity, it is self-limiting in most cases. The diagnosis of XGM can be made by excluding other diseases that elicit inflammation in the breast. The lesion can mimic granular cell tumor, histiocytoid carcinoma, invasive carcinoma NST, and lipid-rich breast cancer; therefore, clinicians should always consider these as differential diagnoses to avoid unnecessary surgery.
Keywords: Xanthogranuloma, Mastitis, Rare